Healthcare Provider Details

I. General information

NPI: 1144639022
Provider Name (Legal Business Name): MARLEE BEDFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 LAKEVIEW DRIVE
BLACKSHEAR GA
31516
US

IV. Provider business mailing address

949 LAKEVIEW DRIVE
BLACKSHEAR GA
31516
US

V. Phone/Fax

Practice location:
  • Phone: 912-807-5006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP008623
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: